Long bone defects represent a significant problem in orthopedic surgery. Current treatment strategies are often fraught with morbidity and complications for the patient and ample opportunity exists to improve current options. While a defect impairing the ability to bear load can occur in any long bone, the most common location is the tibial shall after trauma. The first treatment decision is whether limb salvage or primary amputation is best for the patient. Primary amputation is considered whenever a segmental long bone defect exceeds 10-30 cm. While primary amputation has several clinical advantages, the patient is permanently disabled and at increased risk for becoming destitute, divorced, or depressed. Limb salvage is possible in many circumstances and techniques often employed include limb shortening, distraction osteogenesis, autologous bone graft, free vascularized bone graft, and synthetic bone graft substitutes, all of which involve significant challenges, such as high rates of infection delayed union non-union, and—in major limb trauma—amputation. Patient morbidity, partial functional recovery, and poor quality of healing have long term impact on quality of life after injury. Rehabilitation is slow, painful, and the costs (emotionally, physically, and economically) are prohibitive. These challenges call attention to the significant need for innovation in the development of new bioactive materials and scaffold design.
What is needed in the art are anew method, bioactive material, and/or scaffold design for treating segmental long bone defects without amputation that permits permanent regrowth of bone in the area of the segmental defect, without the problems inherent in current systems.